502 - Patho Gait - Ankle

Front 1

5 purpose of gait analysis

Back 1

1. describe performance.
2. discover dysfunction.
3. determine needs (devices).
4. assess efficacy.
5. predict future status.

Front 2

5 step of gait analysis

Back 2

1. describe gait pattern.
2. identify deviations.
3. measure stride parameters.
4. identify mechanism of dysfunction.
5. assess functional capabilities.

Front 3

5 pathological mechanisms

Back 3

1. inadequate stance stability.
2. inadequate swing clearance.
3. inadequate weight transfer.
4. decreased speed.
5. decreased efficiency.

Front 4

4 characteristics of stroke patients

Back 4

1. forward trunk lean.
2. posterior rotated pelvis.
3. genu recurvatum.
4. plantar flexion.

Front 5

5 characteristics of CP diplegia

Back 5

1. narrow BOS.
2. equinovarus foot.
3. flexed knee.
4. flexed, IR & ADD hip.
5. forward trunk lean. (can have UE weight bearing)

Front 6

what is a rigid contracture

Back 6

cannot be reduced by body weight or manual force

Front 7

what is a elastic contracture?

Back 7

can be reduced by body weight.
cannot be reduced by maual force

Front 8

What is a rigid contracture?

Back 8

persists in both swing and stance.

Front 9

what is 5 step of gait/movement analysis?

Back 9

1. observe client.
2. record deviations and limitations.
3. determine impariemnts.
4. determine treatment for functional improvement.
5. analyze intervention.

Front 10

what are 6 causes of forefoot or flatfoot initial contact?

Back 10

1. weak DF.
2. PF spasticity.
3. PF contracture.
4. extensor synergy.
5. heel pain.
6. excess knee flexion.

Front 11

what are 3 causes of forefoot contact in loading?

Back 11

1. weak DF.
2. knee and hip FX contractures.
3. quads?

Front 12

what are 4 consequences of forefoot contact in loading?

Back 12

1. decreased stride length.
2. reduced or absent heel rocker, reducing forward movement of tibia.
3. inadequate weight transfer.
5. decreased shock absorption.

Front 13

what is the cause of foot slap in loading?

Back 13

weak pre tibial muscles.
TB, EHL, EDL

Front 14

what are 2 consequences of footslap in loading?

Back 14

1. decreased forward momentum (pre tibs don't pull tibia forward).
2. decreased shock absorption by limiting knee flexion

Front 15

what are causes of excess dorsi flexion throughout stance?

Back 15

weak plantar flexors, soleus and or gastroc.
diagnosis spina bifida @ level ??
secondary to hip and knee flexion

Front 16

what are 3 consequences of excess DF in stance?

Back 16

1. increased demand on hip and knee to support bodyweight in WA to SLS.
2. no heel rise in Terminal Stance reduce stride length.
3. Premature IC with CL limb decreasing step length and velocity.

Front 17

what are 4 causes of no heel off in terminal stance?

Back 17

1. weak calf muscles in SLS.
2. ankle or met head pain.
3. inadequate toe extension.
(need 30).
4. weak calf.

Front 18

how do you prevent tibial collapse?

Back 18

with AFO

Front 19

what are 3 causes of excess inversion?

Back 19

1. excess activity of invertors (soleus, posterior tib, anterior tib).
2. plantar flexion contracture.
3. spasticity.

Front 20

what are 4 consequences of excess inversion?

Back 20

1. poor position for WA lead to sprains.
2. decreased shock absorption. (rigid foot).
3. decreases SLS stability.
4. decreased foot clearance in swing if accompanied by PF.

Front 21

5 Causes of excess eversion

Back 21

1 Weak AT & EHL during WA & SLA allow EDL and DF to evert foot.
2. weak Post Tib during WA.
3. Weak Soleus & Post Tib in SLS.
4. Subtalar valgus during WA & SLS.
5. secondary to genu valgus.

Front 22

3 Consequences of excess eversion

Back 22

1. flattened, unsupport arch
2. foot not rigid enough for forefoot rocker in terminal stance.
3. may be compensatory to gain more DF ROM when there is limited ankle ROM in SLS.

Front 23

4 Causes of Premature Heel Off

Back 23

1. Excess PF in WA or SLS. (heel never touches down).
2. Heel pain.
3. Excess knee flexion in WA.
4. Excess knee flexion in SLS. (compensatory to keep pelvis level in unequal leg length)

Front 24

2 Consequences of premature heel off.

Back 24

1. Decreased BOS, increased stability in stance.
2. increased pressure on met head leading to pain and skin breakdwon,

Front 25

4 Causes of foot drag

Back 25

1. excess PF from weak pre tibs or PF contracture.
2. inadequate hip flexion.
3. inadequate knee flexion.
4. impaired proprioception.

Front 26

3 Consequences of foot drag

Back 26

1. fall risk.
2. interfere with swing limb advancement.
3. toe injury with skin breakdown for diabetics.

Front 27

5 Aspects of flexed knee stance.

Back 27

Spina bifida:
1. posterior trunk lean.
2. flexed hips.
3. knee flexion.
4. excessive DF.
5. flat feet.

Front 28

6 Aspects of Genu Recurvatum

Back 28

post polio syndrome:
in loading response.
1. posterior trunk lean.
2. lumbar lordosis.
3. hip extension.
4. knee hyperextension.
5. PF.
6. flatfoot contact.

Front 29

3 Weakness causes of genu recurvatum

Back 29

1. weak knee extensors
2. weak hip extensors.
3. weak ankle PF.

Front 30

6 UMN lesion problems associated with genu recurvatum

Back 30

1. PF contracture.
2. PF spasticity.
3. Extensor synergy.
4. Quad Spasticity.
5. Poor motor control.
6. Proprioception.

Front 31

3 Consequences of genu recurvatum

Back 31

1. decreased shock absorption.
2. interefere with forward tibia advancement.
3. injury to posterior capsule.

Front 32

What is quadriceps avoidance gait?

Back 32

gait with knee in extension/hyperextension to reduce joint reaction force in patello femoral syndrome

Front 33

What are 3 causes of quadriceps avoidance gait?

Back 33

1. ACL deficiency.
2. hamstring on posterior translation of tibia.
3. quad inhibition from pain or joint effusion.

Front 34

What is quadricep weakness stance?

Back 34

1. trunk flexion.
2. knee hyper extension.
3. no quad action.

Front 35

What are 5 causes of limited knee flexion in swing limb advancement?

Back 35

1. weak hip flexors.
2. impaired motor control prevent rapid knee flexion.
3. hypertonicity of knee extensors RF due to UMN.
4. no heel off or inadequate hip extension in terminal stance.
5. knee pain as in from OA.

Front 36

what are 2 consequences of limited knee flexion in swing limb advancement?

Back 36

1. decreased knee flexion in initial swing.
2. may not clear foot.

Front 37

What are 5 compensations to limited knee flexion?

Back 37

1. IL hip hike.
2. CL trunk lean.
3. circumduction.
4. CL Vault (if strong calf).
5. shortened stride.

Front 38

What are 5 causes of excess knee flexion in WA?

Back 38

1. knee flexion contracture.
2. hypertonicity of hamstrings (UMN).
3. excess hip flexion from contracture or spasticity.
4. secondary to excess DF.
5. impaired proprioception.

Front 39

What are 4 consequences of excess knee flexion in WA?

Back 39

1. increased energy use.
2. increased demand on quad and PF.
3. less stability during loading. (pronation, eversion, forefoot AB, free motion in subtalar joint)
4. decreased CL limb clearance.

Front 40

What are 6 causes of excess knee flexion in SLS?

Back 40

1. weak PF. (strong quads).
2. excessive DF ROM.
3. knee flexion contracture.
4. hip flexion contracture.

can have spina bifida at L3.
5. inadequate hip extension.
6. to lower CL limb for IC.

Front 41

Changes in quad activation for flexed knee stance?

Back 41

1. prolonged RF activation.
2. prolonged VMO, VML.
3. RF interfere with knee flexion in swing.

Front 42

What happened in study when they simulated knee contracture?

Back 42

VL activation 4x intensity
VL duration 2x duration
11 degree hip flexion increase
13 degree decrease in stance extension

Front 43

7 causes of inadequate knee extension in SLA

Back 43

1. knee flexion contracture.
2. hypertonic hamstrings.
3. inadequate momentum from hip flexor.
4. attempt to allow forefoot or flatfoot contact.
5. lack of selective control leads to keeping hip/knee flexed in swing.
6. attempt to decrease hip extensor demand at loading.
7. decreased step length.

Front 44

4 causes of knee wobble.

Back 44

1. impaired ankle / knee proprioception.
2. weak quads.
3. quad hypertonicity / spasticity.
4. PF hypertonicity / spasticity.

Front 45

2 consequences of knee wobble.

Back 45

1. decreased forward momentum over stance limb.
2. less stability and balance.

Front 46

what are 5 causes of knee extension thrust?

Back 46

1. WEAK QUADS.
2. PF CONTRACTURE.
3. impaired proprioception.
4. hypertonic quads.
5. attempt to increase knee stability.

Front 47

What are 2 consequences of knee extension thrust?

Back 47

1. pain.
2. recurvatum.

Front 48

what are 5 causes of knee recurvatum in stance?

Back 48

1. PF contracture or spasticity.
2. weak quads.
3. weak PF with weak quads.
4. intentional to increase stability.
5. impaired proprioceptions.

Front 49

9 causes of knee hyperextension in patients with UMN lesions

Back 49

1. impaired motor control.
2. imp proprioceptions.
3. imp balance.
4. imp vision.
5. PF spasticity/contracture.
6. forward trunk lean with retracted pelvis.
7. hip flexion contracture.
8. weak quads.
9. assistive device.

Front 50

5 causes of excessive CL knee flexion.

Back 50

1. knee flexion contracture.
2. UMN hypertonicity of hamstrings.
3. excessive hip flexion due to hip flexoin contracture or spasticity (UMN).
4. secondary to excessive DF.
5. impaired proprioception.

Front 51

4 consequences of increased CL knee flexion

Back 51

1. increased energy expenditure.
2. increased demands on quads and PF.
3. less stability during loading.
4. decreased CL swing limb clearance.

Front 52

4 causes of knee valgus

Back 52

1. RA.
2. trauma.
3. foot alignment abnormalities like pronated ST valgus or C FF varus.
4. hip anteversion with lateral tibial rotation.

Front 53

3 causes of knee varus

Back 53

1. OA.
2. trauma.
3. foot alignment anomalies such as supinated, ST varus, UC FF varus

Front 54

what can cause knee valgus?
(knee adductor moment)

Back 54

hip: adduction, anterversion.
eg weak AB, tight AD, osseous deformity.
foot: forced pronation
eg weak invertors, ST valgus, CFF varus.

Front 55

how to treat knee valgum?

Back 55

1. medial foot wedge orthotic.
2. varus producing knee brace.
3. CL side assistive device.

Front 56

causes of knee varum?

Back 56

1. Lax or torn lateral ligaments such as LCL, ACL, PCL, posterior capsule, IT band.

Front 57

how much more force in medial knee compartment?

Back 57

1. 2.5x, 60-80% of force.

Front 58

how to treat knee varus?

Back 58

1. full sole lateral wedge orthotic.
2. with addition of medial arch and post to lateral wedge, to eliminate medial shift of weight and reduce STJ pronation.

3. valgus knee brace.

Front 59

3 Causes of limited hip flexion in loading
(1 more)

Back 59

1. weak hip extensors.
2. secondary to limited hip flexion in Terminal Swing.
3. Past retract during terminal swing creates extensor motion to lock out knee.
4. forefoot contact

Front 60

5 causes of limited hip flexion in swing

Back 60

1. weak hip flexors.
2. impair motor control (UMN).
3. hip extensor spasticity.\
4. limited SLR ROM. (hamstrings tight).
5. foot drag.

Front 61

4 causes of excess hip flexion in stance

Back 61

1. hip or knee flexion contracture.
2. excessive DF (weak PFor).
3. causes excess knee flexion.
4. use of assistive device.

Front 62

4 consequences of excess hip flexion in stance.

Back 62

1. increased demands on quad sand hip extensors.
2. impaired stability.
3. energy cost increases.
4. decreased stride and step length.

Front 63

2 causes of steppage gait (excessive hip flexion in swing).

Back 63

1. compensatory flexion to clear foot due to weak DF (<3/5) or dropfoot.
2. compensatory for CL knee flexion, for clearance.

Front 64

4 causes of past retract in terminal swing.

Back 64

1. poor motor control.
2. impaired proprioception.
3. intentional to stabilize knee in extention in LR. for amputees.
4. attempts to decrease demand on quids and hip extensors at LR.

Front 65

3 conseuqnces of past retract.

Back 65

1. shorter steps..
2. higher impact forces on knee and heel.
3. heel pain at IC.

Front 66

3 causes of hip internal rotation.

Back 66

1. IR contracture.
2. femoral anteversion.
3. AD spasticity.

Front 67

2 consequences of hip internal rotation.

Back 67

1. patient walks with toe in foot with small BOS.
2. may cause compensatory lateral tibial rotation stressing medial collateral.

Front 68

2 causes of hip external rotation

Back 68

1. attempt to advance over stance limb with limited DF rom.
2. using AD to substitute for weak hip flexors.

Front 69

4 consequences of hip ER

Back 69

1. walk with toe out pattern.
2. increases BOS and decreases forefoot lever and rocker.
(this causes roll over on medial aspect of foot causing hypermobile 1st ray and fallen medial arch).
3. increases stress on medial knee.
4. may help swing clearance.

Front 70

3 causes of hip AD

Back 70

1. hypertonic hip AD.
2. CL pelvic drop.
3. Coxa Valga (>135 degrees).

Front 71

2 conseuqnces of hip AD

Back 71

1. narrowed BOS.
2. interfere with limb clearance.

Front 72

2 conseuqnces of hip AB

Back 72

1. wider BOS for stability, with ER.
2. circumduction when knee flexion or DF is limited.

Front 73

what are 4 aspects of antalgic gait pattern?

Back 73

1. IL lean towards painful hip.
2. decrease joint reaction force.
(by decreasing IMA & GRFV).
3. decreased SLS on affected side.
4. shortened step length bilaterally.

Front 74

3 causes of pelvic hike

Back 74

1. using QL to clear swing limb.
2. generally compensates for weak hip flexors or DF.
3. may compensate for lack of knee FX ROM in pre and initial swing.

Front 75

3 causes of pelvic drop

Back 75

1. weak hip AB.
2. attempt to lower foot for IC.
3. compensate for shorter leg on CL side.

Front 76

4 consequences of pelvic drop

Back 76

1. decrease stability.
2. relative length of CL limb is increased. (closer to ground.)
3. energy demand increased.
4. back pain could result.

Front 77

what are 3 compensations to weak hip AB?

Back 77

IL trunk lean causing:
1. genu valgus.
2. lowered IL shoulder.
3. increased IL arm AB.

Front 78

3 causes of ipsi pelvic drop?

Back 78

1. in stance, compensate for IL short leg.
2. swing, CL weak AB.
3. swing, lower shorter leg for IC.

Front 79

what are 4 causes of anterior pelvic tilt?

Back 79

1. spasticity and or contracture of the hip flexors.
2. weak abdominals.
3. secondary to forward trunk lean.
4. use of assistive device.

Front 80

3 consequence of anterior pelvic tilt?

Back 80

1. lack of hip extension in terminal stance.
2. increased energy cost.
3. increased lordosis. (LBP)

Front 81

5 causes of posterior pelvic tilt?

Back 81

1. tight hamstrings.
2. stance: attempt to decrease hip extensor demand.
3. swing: used to advance limb.
4. LBP.
5. limited lumbar extension ROM.

Front 82

4 causes of lack of forward pelvic rotation? (Tsw, IC, L)

Back 82

1. retracted pelvis. (posterior rotate plus tilt)
2. compensatory to decrease demand on quads and hip extensors in LR.
3. opposite limb lacks pelvic backwards rotation.
4. back pain.

Front 83

2 causes of excessive forward pelvic rotation

Back 83

1. swing: attempt to advance limb.
2. excessive backward rotation of opposite limb.

Front 84

3 causes of lack of backward pelvic rotation in Tst

Back 84

1. impaired motor control, keeps you from rotating pelvis backwards when hip and knee are extended with ankle DF.
2. back pain.
3. lack of backward rotation decrease step length of opposite limb.

Front 85

3 features of retracted pelvis

Back 85

1. posterior rotation with posterior tilt.
2. UMN problem with poor motor control. Is unable to dissociate pelvis from limb movement.
3. Progress over a plantarflexed foot.

Front 86

Some features of backward trunk lean?

Back 86

stance: caused by weak hip extensors
swing: effort to advance limb

requires more energy but reduces momentum.

Front 87

6 causes of foward trunk lean?

Back 87

1. excess hip flexion in WA.
2. inadequate hip extension during SLS.
3. patient attempts to stabilize the knee and ankle in extension by flexing the hip.
4. patient lean on assistive device.
5. trunk extension or hip flexor ROM is limited.
6. patient attempts to progress over a PF ankle.

Front 88

2 or (4) consequences of forward trunk lean?

Back 88

1. increased energy cost.
2. increased demand of hip extensors and back extensors.
(3) LBP
(4) tight hip flexors causing an anterior pelvic tilt.

Front 89

5 causes of lateral trunk lean

Back 89

1. weak IL hip AB.
2. avoid hip pain.
3. compensate for shorter stance limb.
4. attempts to clear swing limb.
5. poor use of assistive device. (cane)

Front 90

4 consequences of lateral trunk lean

Back 90

1. increased energy expenditure.
2. decreased forward momentum.
3. LBP.
4. balance instability.

Front 91

Causes & consequences of posterior trunk rotation?

Back 91

same as posterior pelvic rotation.